Pharmacotherapy Considerations in Advanced Cardiac Life Support

Abstract

Cardiac arrest and sudden cardiac death remain major causes of mortality. Early intervention has been facilitated by emergency medical response systems and the development of training programs in basic life support and advanced cardiac life support (ACLS). Despite the implementation of these programs, the likelihood of a meaningful outcome in many life-threatening situations remains poor. Pharmacotherapy plays a role in the management of patients with cardiac arrest, with new guidelines for ACLS available in 2005 providing recommendations for the role of specific drug therapies. Epinephrine continues as a recommended means to facilitate defibrillation in patients with pulseless ventricular tachycardia or ventricular fibrillation; vasopressin is an alternative. Amiodarone is the primary antiarrhythmic drug that has been shown to be effective for facilitation of defibrillation in patients with pulseless ventricular tachycardia or fibrillation and is also used for the management of atrial fibrillation and hemodynamically stable ventricular tachycardia. Epinephrine and atropine are the primary agents used for the management of asystole and pulseless electrical activity. Treatment of electrolyte abnormalities, severe hypotension, pulmonary embolism, acute ischemic stroke, and toxicologic emergencies are important components of ACLS management. Selection of the appropriate drug, dose, and timing and route of administration are among the many challenges faced in this setting. Pharmacists who are properly educated and trained regarding the use of pharmacotherapy for patients requiring ACLS can help maximize the likelihood of positive patient outcomes.

Analysis of Prehospital Care for Cardiac Arrest in an Urban Setting in Japan

“…Epinephrine and vasopressin are effective drugs for cardiac arrest, as they can stimulate ROSC (9 -11). Epinephrine can facilitate defibrillation, induce positive hemodynamic effects, and increase both systemic pressure and myocardial perfusion (12,13). This study demonstrated the efficacy of epinephrine administration in obtaining PROSC.…”

Safety Report of Ferumoxytol for Magnetic Resonance Imaging in Children and Young Adults

“…Details of these cases are urgently needed to generate improved rescue protocols. It is possible that the presumed anaphylactic reactions were in fact hypotensive reactions, and would have benefitted from treatment with volume administration instead of anaphylactic reaction treatment with vasopressor infusion (38). Guidelines for the treatment of iron infusion related reactions specifically recommend fluids ahead of anaphylaxis therapy (34).…”

Vasopressin Associated With an Increase in Return of Spontaneous Circulation in Acidotic Cardiopulmonary Arrest Patients

“…Routine use of sodium bicarbonate in cardiac arrest is controversial because of a lack of outcome studies and proven benefit. 3,15 Limitations There are limitations associated with this study. This was a single-center analysis with a limited number of participants and was underpowered to detect a difference in the primary outcome.…”